Daily Endocrinology Research Analysis
Analyzed 129 papers and selected 3 impactful papers.
Summary
Across endocrinology, three studies stand out: a registered meta-analysis shows automated insulin delivery improves glucose control in insulin-treated type 2 diabetes; a prospective JAMA study finds 1 in 4 older adults can deprescribe levothyroxine with preserved thyroid function at 1 year; and a multicenter prospective study shows hyperglycemia during acute pancreatitis strongly predicts early-onset diabetes while its absence has high negative predictive value.
Research Themes
- Technology-enabled diabetes care (automated insulin delivery) in T2D
- Thyroid hormone deprescribing in older adults
- Acute pancreatitis-associated dysglycemia as a predictor of incident diabetes
Selected Articles
1. Automated Insulin Delivery Systems in Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis.
This PROSPERO-registered meta-analysis of nine studies (n=1,530) found that automated insulin delivery in insulin-requiring type 2 diabetes increased time-in-range by 16%, reduced time-above-range by 16%, lowered HbA1c by 1.27%, and decreased mean glucose, with a modest reduction in time-below-range and no weight change. Results support integrating AID into management algorithms for T2D on insulin.
Impact: Quantitative synthesis across multiple trials shows clinically meaningful improvements in continuous glucose monitoring metrics and HbA1c in T2D, a population historically excluded from AID. This could accelerate updates to guidelines and payer coverage.
Clinical Implications: For insulin-treated T2D, consider AID to improve time-in-range and HbA1c without increasing hypoglycemia or weight. Programs should address device access, training, and equity to realize these benefits in diverse populations.
Key Findings
- Time-in-range increased by 16.06% (95% CI 10.48–21.65).
- Time-above-range decreased by 15.90% (95% CI −21.44 to −10.36).
- HbA1c decreased by 1.27% (95% CI −2.06 to −0.48).
- Mean glucose decreased by 21.34 mg/dL (95% CI −32.06 to −10.62) with modest TBR reduction and no change in weight/BMI.
Methodological Strengths
- PROSPERO-registered systematic review with predefined outcomes and random-effects meta-analysis.
- Use of standardized CGM endpoints (TIR/TAR/TBR), HbA1c, and mean glucose across studies.
Limitations
- Heterogeneous designs and inclusion of only three randomized controlled trials.
- Imputation of missing data and potential publication bias were noted.
Future Directions: Head-to-head RCTs comparing AID versus optimized basal-bolus therapy in diverse T2D populations, cost-effectiveness analyses, and implementation studies addressing access and training are needed.
BACKGROUND: Automated insulin delivery (AID) systems are the standard of care in type 1 diabetes. Recent studies suggest benefits of these systems for people with type 2 diabetes, as well. PURPOSE: To evaluate the effects of AID systems on glycemic outcomes in people with type 2 diabetes requiring insulin. DATA SOURCES: The PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases were searched through 10 March 2025. This study was registered with PROSPERO (CRD420251036184). STUDY SELECTION: Nine studies (n = 1,530 participants) were included that evaluated AID systems in people with type 2 diabetes reporting continuous glucose monitoring outcomes. DATA EXTRACTION: Data were collected on study characteristics and outcomes including time in range (TIR) (3.9-10.0 mmol/L [70-180 mg/dL]), time above range (TAR) (>10.0 mmol/L [>180 mg/dL]), time below range (TBR) (<3.9 mmol/L [<70 mg/dL]), mean glucose, and HbA1c. We performed a single-arm meta-analysis using a random-effects model. DATA SYNTHESIS: AID systems significantly increased TIR by 16.06% (95% CI 10.48-21.65), was changed TAR by -15.90% (95% CI -21.44 to -10.36), was changed HbA1c by -1.27% (95% CI -2.06 to -0.48), and changed mean glucose by -21.34 mg/dL (95% CI -32.06 to -10.62) or 1.19 mmol/L (95% CI -1.78 to -0.59). There was a modest yet significant reduction in TBR. There were no changes in body weight or BMI. LIMITATIONS: Heterogeneous study designs, including only three randomized controlled trials, and imputed missing data. CONCLUSIONS: AID systems improved glucose control in a diverse population of individuals with type 2 diabetes requiring insulin therapy with reduction in hypoglycemia. These findings support recommendations for AID systems use in future type 2 diabetes management guidelines.
2. Discontinuation of Levothyroxine in Adults Aged 60 Years or Older.
In a single-group, prospective deprescribing protocol across 58 practices, 25.7% of adults ≥60 years maintained adequate thyroid function 1 year after stopping levothyroxine; success was 63.6% among those on ≤50 µg/day. Thyroid-related quality of life did not worsen.
Impact: This practice-changing deprescribing study challenges the assumption of lifelong levothyroxine in older adults and provides actionable criteria (dose ≤50 µg/day) to guide supervised discontinuation.
Clinical Implications: For adults ≥60 years on stable low-to-moderate levothyroxine doses with TSH <10 mIU/L, clinicians should consider a monitored, stepwise deprescribing trial with thyroid testing ≥6 weeks after each dose change.
Key Findings
- Overall, 25.7% (95/370) successfully discontinued levothyroxine at 1 year with TSH <10 mIU/L and normal free T4.
- Among those on ≤50 µg/day, 63.6% (56/88) discontinued successfully.
- No clinically relevant deterioration in thyroid-related quality of life was observed.
Methodological Strengths
- Prospective, protocolized stepwise dose reduction with objective laboratory endpoints.
- Multi-site primary care setting (58 practices) enhances generalizability within older adults.
Limitations
- Single-group, open-label design without a control arm limits causal inference.
- Selection limited to community-dwelling older adults with TSH <10 mIU/L and stable doses may reduce generalizability.
Future Directions: Randomized deprescribing trials comparing stepwise discontinuation versus continuation, identification of biomarkers predicting successful discontinuation, and health-economic analyses of deprescribing pathways.
IMPORTANCE: Many adults aged 60 years or older take the thyroid hormone levothyroxine, which is generally continued for life. However, it is uncertain whether long-term continuation is always necessary. OBJECTIVE: To determine the percentage of adults aged 60 years or older who can successfully discontinue levothyroxine treatment. DESIGN, SETTING, AND PARTICIPANTS: This single-group, prospective study included community-dwelling adults aged 60 years or older who were taking levothyroxine at a stable dosage (≤150 µg/d) for at least 1 year and had a thyrotropin (TSH) level of less than 10 mIU/L. The study was conducted at 58 general practices in the Netherlands. Participants were enrolled between January 2020 and July 2022 and final follow-up occurred on December 12, 2023. INTERVENTIONS: Open-label, protocol-driven, stepwise dose reduction with thyroid function testing performed at least 6 weeks after each reduction in levothyroxine dose. MAIN OUTCOMES AND MEASURES: The primary outcome was the proportion of participants who discontinued levothyroxine and had both a thyrotropin level of less than 10 mIU/L and a free thyroxine level within the reference range at 1 year after the start of discontinuation. The secondary outcomes included factors associated with successful discontinuation (demographics, thyroid function, dose) and thyroid-related quality of life. RESULTS: Of the 370 participants who started the levothyroxine discontinuation phase (median age, 70 [range, 60-89] years; 80% female; median thyrotropin level, 2.2 [range, 0.02-9.69] mIU/L; mean free thyroxine level, 1.21 [SD, 0.18] ng/dL), 366 completed final follow-up at 1 year. Of the 370 participants (median levothyroxine dose at baseline, 50 [range, 12.5-150] µg/d), 95 (25.7% [95% CI, 21.5%-30.4%]) successfully stopped taking levothyroxine and had a median thyrotropin level of 5.03 mIU/L (range, 1.56-9.40 mIU/L) and a mean free thyroxine level of 1.01 ng/dL (range, 0.80-1.43 ng/dL) at 1 year. Of the 95 participants who successfully discontinued levothyroxine, 46 (48.4% [95% CI, 38.6%-58.3%]) had a thyrotropin level of less than 4.8 mIU/L. Among the 88 participants taking a levothyroxine dose of 50 µg/d or lower, 56 (63.6%) successfully discontinued this treatment. Thyroid-related quality of life showed no clinically relevant changes overall from baseline to 1 year and stratified by successful levothyroxine discontinuation vs unsuccessful discontinuation. CONCLUSIONS AND RELEVANCE: In this open-label, single-group prospective study, 25.7% of adults aged 60 years or older discontinued levothyroxine treatment while maintaining adequate thyroid function at 1 year. Evaluation of the need to continue levothyroxine should be considered in adults aged 60 years or older, particularly in those taking a dose of 50 µg/d or lower.
3. Hyperglycemia During Acute Pancreatitis and Progression to Early-Onset Diabetes After Recovery: Preliminary Findings From the Diabetes Related to Acute Pancreatitis and Its Mechanisms (DREAM) Study.
In 395 participants without preexisting diabetes, hyperglycemia during acute pancreatitis was common (HDAP140: 37.5%; HDAP200: 7.1%) and strongly predicted early-onset diabetes after recovery (14.8% vs 1.2% for HDAP140; 42.9% vs 3.5% for HDAP200). Absence of HDAP carried high negative predictive value (99% for HDAP140; 97% for HDAP200).
Impact: Defines pragmatic glycemic thresholds during acute pancreatitis that stratify short-term diabetes risk with very high negative predictive value, enabling targeted follow-up and resource allocation.
Clinical Implications: Measure and document peak glucose during acute pancreatitis. Individuals with peak glucose >200 mg/dL warrant prioritized postdischarge diabetes screening; those without HDAP can be reassured with less intensive short-term monitoring.
Key Findings
- HDAP140 (peak glucose >140 mg/dL) occurred in 37.5%; HDAP200 (>200 mg/dL) in 7.1%.
- Early-onset diabetes after recovery: 14.8% with HDAP140 vs 1.2% without; 42.9% with HDAP200 vs 3.5% without (both P=0.0001).
- Absence of HDAP140 and HDAP200 had negative predictive values of 99% and 97%, respectively.
Methodological Strengths
- Prospective multicenter design with predefined HDAP thresholds.
- Standardized post-AP glycemic phenotyping using fasting glucose, OGTT, and HbA1c.
Limitations
- Short-term follow-up (median ~111 days) limits assessment of long-term diabetes incidence.
- Observational analysis susceptible to residual confounding (etiology/severity effects).
Future Directions: Longer-term prospective cohorts to define durability of risk, randomized trials of early glycemic interventions post-AP in HDAP200, and mechanistic studies to disentangle stress versus islet injury contributions.
OBJECTIVE: Hyperglycemia during acute pancreatitis (HDAP) likely reflects both stress hormone responses and pancreatic islet injury, distinguishing it from typical stress-induced hyperglycemia. The aim of this study was to determine the prevalence of HDAP and its prognostic significance for early-onset diabetes following acute pancreatitis (AP). RESEARCH DESIGN AND METHODS: Diabetes Related to Acute Pancreatitis and Its Mechanisms (DREAM) is a prospective multicenter study examining the development of diabetes following AP. This analysis included 395 participants without prior diabetes with an AP episode, focusing on their glucose levels during the event. Two definitions of HDAP were examined: peak glucose >140 mg/dL (HDAP140) and >200 mg/dL (HDAP200). Outpatient glycemic status after recovery (median: 111 days post-AP) was evaluated using fasting glucose, oral glucose tolerance test, and HbA1c. RESULTS: HDAP140 and HDAP200 were present in 37.5% and 7.1% of participants, respectively. Age, race, etiology, and AP severity were significant predictors of HDAP140. Among participants with HDAP140, 14.8% developed early-onset diabetes after AP recovery vs. 1.2% in those without (P = 0.0001). In those with HDAP200, 42.9% developed early-onset diabetes vs. 3.5% in those without (P = 0.0001). The absence of HDAP140 and HDAP200 was associated with negative predictive values of 99% and 97%, respectively, for diabetes. CONCLUSIONS: HDAP can be common in individuals without diabetes and is associated with early-onset diabetes following AP. Individuals without HDAP have a low risk of diabetes short term, while those with HDAP200 are at high risk. Monitoring glycemia during AP can identify individuals best suited for early targeted postdischarge care.